Cancer, Detection & Treatment

The information provided below has been modified from that furnished by the National Institutes of Health and the National Cancer Institute of the United States of America.
How can cancer be detected early?

In many cases, the sooner cancer is diagnosed and treated, the better a person's chance for a full recovery. If you develop cancer, you can improve the chance that it will be detected early if you have regular medical checkups and do certain self-exams. Often a doctor can find early cancer during a physical exam or with routine tests, even if a person has no symptoms. Some important medical exams, tests, and self- exams are discussed on the next pages. The doctor may suggest other exams for people who are at increased risk for cancer.
Ask your doctor about your cancer risk, problems to watch for, and a schedule of regular checkups. The doctor's advice will be based on your age, medical history, and other risk factors. The doctor also can help you learn about self-exams. (More information and free booklets about self-exams are available from the Cancer Information Service).
Many local health departments have information about cancer screening or early detection programs. The Cancer Information Service also can tell you about such programs.
Exams For Both Men And Women

Skin - The doctor should examine your skin during regular checkups for signs of skin cancer. You should also check regularly for new growths, sores that do not heal, changes in the size, shape, or color of any moles, or any other changes on the skin. Warning signs like these should be reported to the doctor right away.
Colon and Rectum - Beginning at age 50, you should have a yearly fecal occult blood test. This test is a check for hidden (occult) blood in the stool. A small amount of stool is placed on a plastic slide or on special paper. It may be tested in the doctor's office or sent to a lab. This test is done because cancer of the colon and rectum can cause bleeding. However, noncancerous conditions can also cause bleeding, so having blood in the stool does not necessarily mean a person has cancer. If blood is found, the doctor orders more tests to help make a diagnosis.
To check for cancer of the rectum, the doctor inserts a gloved finger into the rectum and feels for any bumps or abnormal areas. A digital rectal exam should be done during regular checkups.
Every 3 to 5 years after age 50, an individual should have sigmoidoscopy. In this exam, the doctor uses a thin, flexible tube with a light to look inside the rectum and colon for abnormal areas.
Mouth - Your doctor and dentist should examine your mouth at regular visits. Also, by looking in a mirror, you can check inside your mouth for changes in the color of the lips, gums, tongue, or inner cheeks, and for scabs, cracks, sores, white patches, swelling, or bleeding. It is often possible to see or feel changes in the mouth that might be cancer or a condition that might lead to cancer. Any symptoms in your mouth should be checked by a doctor or dentist. Oral exams are especially important for people who use alcohol or tobacco products and for anyone over age 50.
Exams For Men

Prostate - Men over age 40 should have a yearly digital rectal exam to check the prostate gland for hard or lumpy areas. The doctor feels the prostate through the wall of the rectum.
Testicles - Testicular cancer occurs most often between ages 15 and 34. Most of these cancers are found by men themselves, often by doing a testicular self-exam. If you find a lump or notice another change, such as heaviness, swelling, unusual tenderness, or pain, you should see your doctor. Also, the doctor should examine the testicles as part of regular medical checkups.
Exams For Women

Breast - When breast cancer is found early, a woman has more treatment choices and a good chance of complete recovery. It is, therefore, important that breast cancer be detected as early as possible. The National Cancer Institute encourages women to take an active part in early detection. They should talk to their doctor about this disease, the symptoms to watch for, and an appropriate schedule of checkups. Women should ask their doctor about:

• Mammograms (x-rays of the breast);
• Breast exams by a doctor or nurse; and
• Breast self-examination (BSE)

A mammogram can often show tumors or changes in the breast before they can be felt or cause symptoms. However, we know mammograms cannot find every abnormal area in the breast. This is especially true in the breasts of young women. Another important step in early detection is for women to have their breasts examined regularly by a doctor or a nurse.
Between visits to the doctor, women should examine their breasts every month. By doing BSE, women learn what looks and feels normal for their breasts, and they are more likely to find a change. Any changes should be reported to the doctor. Most breast lumps are not cancer, but only a doctor can make a diagnosis.
Cervix - Regular pelvic exams and Pap tests are important to detect early cancer of the cervix. In a pelvic exam, the doctor feels the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum for any change in size or shape.
For the Pap test, a sample of cells is collected from the upper vagina and cervix with a small brush or a flat wooden stick. The sample is placed in a glass slide and checked under a microscope for cancer or other abnormal cells.
Women should start having a Pap test every year after they turn 18 or become sexually active. If the results are normal for 3 or more years in a row, a woman may have this test less often, based on her doctor's advice.

What are symptoms of cancer?

You should see your doctor for regular checkups and not wait for problems to occur. But you should also know that the following symptoms may be associated with cancer: changes in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, thickening or lump in the breast or any other part of the body, indigestion or difficulty swallowing, obvious change in a wart or mole, or nagging cough or hoarseness. These symptoms are not always a sign of cancer. They can also be caused by less serious conditions. Only a doctor can make a diagnosis. It is important to see a doctor if you have any of these symptoms. Don't wait to feel pain. Early cancer usually does not cause pain.
How is cancer diagnosed?

If you have a sign or symptom that might mean cancer, the doctor will do a physical exam and ask about your medical history. In addition, the doctor usually orders various tests and exams. These may include imaging procedures, which produce pictures of areas inside the body, endoscopy, which allows the doctor to look directly inside certain organs, and laboratory tests. In most cases, the doctor also orders a biopsy, a procedure in which a sample of tissue is removed. A pathologist examines the tissue under a microscope to check for cancer cells.
Imaging

Images of areas inside the body help the doctor tell whether a tumor is present. These images can be made in several ways. In many cases, the doctor uses a special dye so that certain organs show up better on film. The dye may be swallowed or put into the body through a needle or a tube.
X-rays are the most common way doctors made pictures of the inside of the body. In a special kind of x-ray imaging, a CT or CAT scan uses a computer linked to an x-ray machine to make a series of detailed pictures.
In radionuclide scanning, the patient swallows or is given an injection of a mildly radioactive substance. A machine (scanner) measures radioactivity levels in certain organs and prints a picture on paper or films. By looking at the amount of radioactivity in the organs, the doctor can find abnormal areas.
Ultrasonography is another procedure for viewing the inside of the body. High-frequency sound waves that cannot be heard by humans enter the body and bounce back. Their echoes produce a picture called a sonogram. These pictures are shown on a monitor like a TV screen and can be printed on paper.
In MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas in the body. These pictures are viewed on a monitor and can also be printed.
Endoscopy

Endoscopy allows the doctor to look into the body through a thin, lighted tube called an endoscope. The exam is named for the organ involved (for example, colonoscopy to look inside the colon). During the exam, the doctor may collect tissue or cells for closer examination.
Laboratory Tests

Although no single test can be used to diagnose cancer, laboratory tests such as blood and urine tests give the doctor important information. If cancer is present, the lab work can show the effects of the disease on the body. In some cases, special tests are used to measure the amount of certain substances in the blood, urine, and other body fluids, or tumor tissue. The levels of these substances may become abnormal when certain kinds of cancer are present.
Biopsy

The physical exam, imaging, endoscopy, and lab tests can show that something abnormal is present, but a biopsy is the only sure way to know whether the problem is cancer. In a biopsy, the doctor removes a sample of tissue from the abnormal area or may remove the whole tumor. A pathologist examines the tissue under a microscope. If cancer is present, the pathologist can usually tell what kind of cancer it is and may be able to judge whether the cells are likely to grow slowly or quickly.
Staging

When cancer is found, the patient's doctor needs to know the stage, or extent, of the disease to plan the best treatment. The doctor may order various tests and exams to find out whether the cancer has spread and, if so, what parts of the body are affected. In some cases, lymph nodes near the tumor are removed and checked for cancer cells. If cancer cells are found in the lymph nodes, it may mean that the cancer has spread to other organs.

How is cancer treated?

Cancer is treated with surgery, radiation therapy, chemotherapy, hormone therapy, or biological therapy. Patients with cancer are often treated by a team of specialists, which may include a medical oncologist (specialist in cancer treatment), a surgeon, a radiation oncologist (specialist in radiation therapy), and others. The doctors may decide to use one treatment method or a combination of methods. The choice of treatment depends on the type and location of the cancer, the stage of the disease, the patient's age and general health, and other factors.
Some cancer patients take part in a clinical trial (research study) using new treatment methods. Such studies are designed to improve cancer treatment.
Getting A Second Opinion

Before starting treatment, the patient may want another doctor to review the diagnosis and treatment plan. Some insurance companies require a second opinion; others may pay for a second opinion if the patient requests it. There are a number of ways to find specialists to consult for a second opinion.
The patient's doctor may suggest a specialist for a second opinion.
The Cancer Information Service, at 1-800-4-CANCER, can tell callers about treatment facilities, including cancer centers and other programs in their area supported by the National Cancer Institute.
Patients can get the names of doctors from their local medical society, a nearby hospital, or a medical school.
Preparing For Treatment

Many people with cancer want to learn all they can about their disease and their treatment choices so they can take an active part in decisions about their medical care. Often, it helps to make a list of questions to ask the doctor. Patients may take notes or, with the doctor's consent, tape record the discussion. Some patients also find it helps to have a family member or friend with them when they talk with the doctor, to take part in the discussion, to take notes, or just to listen.
When a person is diagnosed with cancer, shock and stress are natural reactions. These feelings may make it difficult to think of every question to ask the doctor. Patients may find it hard to remember everything the doctor says. The should not feel they need to ask all their questions or remember all the answers at one time. They will have other chances for the doctor to explain things that are not clear and to ask for more information.
Methods Of Treatment

Surgery - Surgery is local treatment to remove the tumor. Tissue around the tumor and nearby lymph nodes may also be removed during the operation.
Radiation Therapy - In radiation therapy (also called radiotherapy), high-energy rays are used to damage cancer cells and stop them from growing and dividing. Like surgery, radiation therapy is a local treatment; it affects cancer cells only in the treated area. Radiation can come from a machine (external radiation). It can also come from an implant (a small container of radioactive material) placed directly into or near the tumor (internal radiation). Some patients receive both kinds of radiation therapy.
External radiation therapy is usually given on an outpatient basis in a hospital or clinic 5 days a week for several weeks. Patients are not radioactive during or after the treatment.
For internal radiation therapy, the patient stays in the hospital for a few days. The implant may be temporary or permanent. Because the level of radiation is highest during the hospital stay, patients may not be able to have visitors or may have visitors only for a short time. Once an implant is removed, there is no radioactivity in the body. The amount of radiation in a permanent implant goes down to a safe level before the patient leaves the hospital.
Chemotherapy - Treatment with drugs to kill cancer cells is called chemotherapy. Most anticancer drugs are injected into a vein (IV) or a muscle. Some are given by mouth. Chemotherapy is systemic treatment, meaning that the drugs flow through the bloodstream to nearly every part of the body.
Often, patients who need many doses of IV chemotherapy receive the drugs through a catheter (a thin flexible tube). One end of the catheter is placed in a large vein in the chest. The other end is outside the body or attached to a small device just under the skin. Anticancer drugs are given through the catheter. This can make chemotherapy more comfortable for the patient. Patients and their families are shown how to care for the catheter and keep it clean. For some types of cancer, doctors are studying whether it helps to put anticancer drugs directly into the affected area.
Chemotherapy is generally given in cycles: a treatment period is followed by a recovery period, then another treatment period, and so on. Usually a patient has chemotherapy as an outpatient at the hospital, at the doctor's office, or at home. However, depending on which drugs are given and the patient's general health, the patient may need to stay in the hospital for a short time.
Hormone Therapy - Some types of cancer, including most breast and prostate cancers, depend on hormones to grow. For this reason, doctors may recommend therapy that prevents cancer cells from getting or using the hormones they need. Sometimes, the patient has surgery to remove organs (such as the ovaries or testicles) that make the hormones. In other cases, the doctor uses drugs to stop hormone production or change the way hormones work. Like chemotherapy, hormone therapy is a systemic treatment; it affects cells throughout the body.
Biological Therapy - Biological therapy (also called immunotherapy) is a form of treatment that uses the body's natural ability (immune system) to fight infection and disease or to protect the body from some of the side effects of treatment. Monoclonal antibodies, interferon, interleukin-2 (IL-2), and several types of colony-stimulating factors (CSF, GM-CSF, G-CSF) are forms of biological therapy.

What are the side effects of cancer treatment?

It is hard to limit the effects of treatment so that only cancer cells are removed or destroyed. Because treatment also damages healthy cells and tissues, it often causes unpleasant side effects.
The side effects of cancer treatment vary. They depend mainly on the type and extent of the treatment. Also, each person reacts differently. Attempts are made to plan the patient's therapy to keep side effects to a minimum. Patients are monitored during therapy so that any problems which occur can be addressed.
Surgery - The side effects of surgery depend on the location of the tumor, the type of operation, the patient's general health, and other factors. Although patients are often uncomfortable during the first few days after surgery, this pain can be controlled with medicine. Patients should feel free to discuss pain relief with the doctor or nurse. It is also common for patients to feel tired or weak for a while. The length of time it takes to recover from an operation varies for each patient.
Radiation Therapy - With radiation therapy, the side effects depend on the treatment dose and the part of the body that is treated. The most common side effects are tiredness, skin reactions (such as a rash or redness) in the treated area, and loss of appetite. Radiation therapy can also cause a decrease in the number of white blood cells, cells that help protect the body against infection. Although the side effects of radiation therapy can be unpleasant, they can usually be treated or controlled. It also helps to know that, in most cases, they are not permanent.
Chemotherapy - The side effects of chemotherapy depend mainly on the drugs and the doses the patient receives. Generally, anticancer drugs affect cells that divide rapidly. These include blood cells, which fight infection, help the blood to clot, or carry oxygen to all parts of the body. When blood cells are affected by anticancer drugs, patients are more likely to develop infections, may bruise or bleed easily, and may have less energy. Cells that line the digestive tract also divide rapidly. As a result of chemotherapy, patients can have side effects, such as loss of appetite, nausea and vomiting, hair loss, or mouth sores. For some patients, medicines can be prescribed to help with side effects, especially with nausea and vomiting. Usually these side effects gradually go away during the recovery period or after treatment stops.
Hair loss, another side effect of chemotherapy, is a major concern for many patients. Some chemotherapy drugs only cause the hair to thin out, while others may result in the loss of all body hair. Patients may feel better if they decide how to handle hair loss before starting treatment.
In some men and women, chemotherapy drugs cause changes that may result in a loss of fertility (the ability to have children). Loss of fertility can be temporary or permanent depending on the drugs used and the patient's age. For men, sperm banking before treatment may be a choice. Women's menstrual periods may stop, and they may have hot flashes and vaginal dryness. Periods are more likely to return in young women.
In some cases, bone marrow transplantation and peripheral stem cell support are used to replace tissue that forms blood cells when that tissue has been destroyed by the effects of chemotherapy or radiation therapy.
Hormone Therapy - Hormone therapy can cause a number of side effects. Patients can have nausea and vomiting, swelling or weight gain, and, in some cases, hot flashes. In women, hormone therapy can also cause interrupted menstrual periods, vaginal dryness, and, sometimes, loss of fertility. Hormone therapy in men can cause impotence, loss of sexual desire, or loss of fertility. These changes may be temporary, long-lasting, or permanent.
Biological Therapy - The side effects of biological therapy depend on the type of treatment. Often, these treatments cause flu-like symptoms such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Some patients develop a rash, and some bleed or bruise easily. In addition, interleukin therapy can cause swelling. Depending on how severe these problems are, patients may need to stay in the hospital during treatment. These side effects are usually short-term and they gradually go away after treatment stops.
Doctors and nurses can explain the side effects of cancer treatment and help with any problems can occur.

How important is nutrition for cancer patients?

Some patients lose their appetite and find it hard to eat well. In addition, the common side effects of treatment, such as nausea, vomiting, or mouth sores, can make it difficult to eat. For some patients, foods taste different. Also, people may not feel like eating when they are uncomfortable or tired.
Patients who eat well during cancer treatment often feel better and have more energy. In addition, they may be better able to handle the side effects of treatment. Eating well means getting enough calories and protein to help prevent weight loss and regain strength.
Doctors, nurses, and dietitians can offer advice for healthy eating during cancer treatment. Patients and their families also may want to read the National Cancer Institute booklet Eating Hints: Recipes and Tips For Better Nutrition During Cancer Treatment , which contains many useful suggestions.
What are clinical trials?

When laboratory research shows that a new treatment method has promise, cancer patients can receive the treatment in carefully controlled trials. These trials are designed to find out whether the new approach is both safe and effective and to answer scientific questions. Often, clinical trials compare a new treatment with a standard approach so that doctors can learn which is more effective.
Researchers also look for ways to reduce the side effects of treatment and improve the quality of patients' lives. Patients who take part in clinical trials make an important contribution to medical science. These patients take certain risks, but they also may have the first chance to benefit from improved treatment methods.
Clinical trials offer important options for many patients. Cancer patients who are interested in taking part in a clinical trial should talk with their doctor. They may want to read What Are Clinical Trials All About?, a booklet that explains treatment studies and outlines some of their possible benefits and risks.
One way to learn about clinical trials is through PDQ, a computerized resource developed by the National Cancer Institute. PDQ contains information about cancer treatment and about clinical trials in progress all over the country. The Cancer Information Service can provide PDQ information to doctors, patients, and the public.

What other support is there for cancer patients?

Living with a serious disease is difficult. Cancer patients and those who care about them face many problems and challenges. Coping with these difficulties is easier when people have helpful information and support services.
Cancer patients may worry about holding their job, caring for their family, or keeping up with daily activities. Worries about tests, treatments, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team can answer questions about treatment, working, or other activities. Meeting with a nurse, social worker, counselor, or a member of the clergy also can be helpful to patients who want to talk about their feelings or discuss their concerns about the future or about personal relationships.
Friends and relatives, especially those who have had personal experience with cancer, can be very supportive. Also, it helps many patients to meet with others who are facing problems like theirs. Cancer patients often get together in support groups, where they can share what they have learned about cancer and its treatment and about coping with the disease. It is important to keep in mind, however, that each patient is different. Treatments and ways of dealing with cancer that work for one person may not be right for another, even if they both have the same kind of cancer. It is a good idea to discuss the advice of friends and family members with the doctor.
Often, a social worker at the hospital or clinic can suggest groups that can help with rehabilitation, emotional support, financial aid, transportation, or home care. The American Cancer Society has many services for patients and families. Local offices of the American Cancer Society are listed in the white pages of the telephone directory. The Cancer Information Service also has information on local services.
source:medicinenet.com
 

Chemotherapy

What is chemotherapy?

Chemotherapy (also called chemo) is a type of cancer treatment that uses drugs to destroy cancer cells.

How does chemotherapy work?

Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. But it can also harm healthy cells that divide quickly, such as those that line your mouth and intestines or cause your hair to grow. Damage to healthy cells may cause side effects. Often, side effects get better or go away after chemotherapy is over.

What does chemotherapy do?

Depending on your type of cancer and how advanced it is, chemotherapy can:

• Cure cancer - when chemotherapy destroys cancer cells to the point that your doctor can no longer detect them in your body and they will not grow back.



• Control cancer - when chemotherapy keeps cancer from spreading, slows its growth, or destroys cancer cells that have spread to other parts of your body.



• Ease cancer symptoms (also called palliative care) - when chemotherapy shrinks tumors that are causing pain or pressure.

How is chemotherapy used?

Sometimes, chemotherapy is used as the only cancer treatment. But more often, you will get chemotherapy along with surgery, radiation therapy, or biological therapy. Chemotherapy can:

• Make a tumor smaller before surgery or radiation therapy. This is called neo-adjuvant chemotherapy.



• Destroy cancer cells that may remain after surgery or radiation therapy. This is called adjuvant chemotherapy.



• Help radiation therapy and biological therapy work better.



• Destroy cancer cells that have come back (recurrent cancer) or spread to other parts of your body (metastatic cancer).

How does my doctor decide which chemotherapy drugs to use?

This choice depends on:

• The type of cancer you have. Some types of chemotherapy drugs are used for many types of cancer. Other drugs are used for just one or two types of cancer.



• Whether you have had chemotherapy before



• Whether you have other health problems, such as diabetes or heart disease

Where do I go for chemotherapy?

You may receive chemotherapy during a hospital stay, at home, or in a doctor's office, clinic, or outpatient unit in a hospital (which means you do not have to stay overnight). No matter where you go for chemotherapy, your doctor and nurse will watch for side effects and make any needed drug changes.

How often will I receive chemotherapy?

Treatment schedules for chemotherapy vary widely. How often and how long you get chemotherapy depends on:

• Your type of cancer and how advanced it is



• The goals of treatment (whether chemotherapy is used to cure your cancer, control its growth, or ease the symptoms)



• The type of chemotherapy



• How your body reacts to chemotherapy

You may receive chemotherapy in cycles. A cycle is a period of chemotherapy treatment followed by a period of rest. For instance, you might receive 1 week of chemotherapy followed by 3 weeks of rest. These 4 weeks make up one cycle. The rest period gives your body a chance to build new healthy cells.

Can I miss a dose of chemotherapy?

It is not good to skip a chemotherapy treatment. But sometimes your doctor or nurse may change your chemotherapy schedule. This can be due to side effects you are having. If this happens, your doctor or nurse will explain what to do and when to start treatment again.

How is chemotherapy given?

Chemotherapy may be given in many ways.

• Injection. The chemotherapy is given by a shot in a muscle in your arm, thigh, or hip or right under the skin in the fatty part of your arm, leg, or belly.



• Intra-arterial (IA). The chemotherapy goes directly into the artery that is feeding the cancer.



• Intraperitoneal (IP). The chemotherapy goes directly into the peritoneal cavity (the area that contains organs such as your intestines, stomach, liver, and ovaries).



• Intravenous (IV). The chemotherapy goes directly into a vein.



• Topically. The chemotherapy comes in a cream that you rub onto your skin.



• Orally. The chemotherapy comes in pills, capsules, or liquids that you swallow.

Things to know about getting chemotherapy through an IV Chemotherapy is often given through a thin needle that is placed in a vein on your hand or lower arm. Your nurse will put the needle in at the start of each treatment and remove it when treatment is over. Let your doctor or nurse know right away if you feel pain or burning while you are getting IV chemotherapy. IV chemotherapy is often given through catheters or ports, sometimes with the help of a pump. Catheters. A catheter is a soft, thin tube. A surgeon places one end of the catheter in a large vein, often in your chest area. The other end of the catheter stays outside your body. Most catheters stay in place until all your chemotherapy treatments are done. Catheters can also be used for drugs other than chemotherapy and to draw blood. Be sure to watch for signs of infection around your catheter. Ports. A port is a small, round disc made of plastic or metal that is placed under your skin. A catheter connects the port to a large vein, most often in your chest. Your nurse can insert a needle into your port to give you chemotherapy or draw blood. This needle can be left in place for chemotherapy treatments that are given for more than 1 day. Be sure to watch for signs of infection around your port. Pumps. Pumps are often attached to catheters or ports. They control how much and how fast chemotherapy goes into a catheter or port. Pumps can be internal or external. External pumps remain outside your body. Most people can carry these pumps with them. Internal pumps are placed under your skin during surgery.

How will I feel during chemotherapy?

Chemotherapy affects people in different ways. How you feel depends on how healthy you are before treatment, your type of cancer, how advanced it is, the kind of chemotherapy you are getting, and the dose. Doctors and nurses cannot know for certain how you will feel during chemotherapy.
Some people do not feel well right after chemotherapy. The most common side effect is fatigue, feeling exhausted and worn out. You can prepare for fatigue by:

• Asking someone to drive you to and from chemotherapy



• Planning time to rest on the day of and day after chemotherapy



• Getting help with meals and childcare the day of and at least 1 day after chemotherapy

There are many ways you can help manage chemotherapy side effects.

Can I work during chemotherapy?

Many people can work during chemotherapy, as long as they match their schedule to how they feel. Whether or not you can work may depend on what kind of work you do. If your job allows, you may want to see if you can work part-time or work from home on days you do not feel well.
Many employers are required by law to change your work schedule to meet your needs during cancer treatment. Talk with your employer about ways to adjust your work during chemotherapy. You can learn more about these laws by talking with a social worker.

Can I take over-the-counter and prescription drugs while I get chemotherapy?

This depends on the type of chemotherapy you get and the other types of drugs you plan to take. Take only drugs that are approved by your doctor or nurse. Tell your doctor or nurse about all the over-the-counter and prescription drugs you take, including laxatives, allergy medicines, cold medicines, pain relievers, aspirin, and ibuprofen.
One way to let your doctor or nurse know about these drugs is by bringing in all your pill bottles. Your doctor or nurse needs to know:

• The name of each drug



• The reason you take it



• How much you take



• How often you take it

Talk to your doctor or nurse before you take any over-the-counter or prescription drugs, vitamins, minerals, dietary supplements, or herbs.

Can I take vitamins, minerals, dietary supplements, or herbs while I get chemotherapy?
Some of these products can change how chemotherapy works. For this reason, it is important to tell your doctor or nurse about all the vitamins, minerals, dietary supplements, and herbs that you take before you start chemotherapy. During chemotherapy, talk with your doctor before you take any of these products.

How will I know if my chemotherapy is working?

Your doctor will give you physical exams and medical tests (such as blood tests and x-rays). He or she will also ask you how you feel.
You cannot tell if chemotherapy is working based on its side effects. Some people think that severe side effects mean that chemotherapy is working well. Or that no side effects mean that chemotherapy is not working. The truth is that side effects have nothing to do with how well chemotherapy is fighting your cancer.

How much does chemotherapy cost?

It is hard to say how much chemotherapy will cost. It depends on:

• The types and doses of chemotherapy used



• How long and how often chemotherapy is given



• Whether you get chemotherapy at home, in a clinic or office, or during a hospital stay



• The part of the country where you live

Does my health insurance pay for chemotherapy?
Talk with your health insurance plan about what costs it will pay for. Questions to ask include:

• What will my insurance pay for?



• Do I or does the doctor's office need to call my insurance company before each treatment for it to be paid for?



• What do I have to pay for?



• Can I see any doctor I want or do I need to choose from a list of preferred providers?



• Do I need a written referral to see a specialist?



• Is there a co-pay (money I have to pay) each time I have an appointment?



• Is there a deductible (certain amount I need to pay) before my insurance pays?



• Where should I get my prescription drugs?



• Does my insurance pay for all my tests and treatments, whether I am an inpatient or outpatient?

How can I best work with my insurance plan?

• Read your insurance policy before treatment starts to find out what your plan will and will not pay for.



• Keep records of all your treatment costs and insurance claims.



• Send your insurance company all the paperwork it asks for. This may include receipts from doctors' visits, prescriptions, and lab work. Be sure to also keep copies for your own records.



• As needed, ask for help with the insurance paperwork. You can ask a friend, family member, social worker, or local group such as a senior center.



• If your insurance does not pay for something you think it should, find out why the plan refused to pay. Then talk with your doctor or nurse about what to do next. He or she may suggest ways to appeal the decision or other actions to take.

What are clinical trials and are they an option for me?

Cancer clinical trials (also called cancer treatment studies or research studies) test new treatments for people with cancer. These can be studies of new types of chemotherapy, other types of treatment, or new ways to combine treatments. The goal of all these clinical trials is to find better ways to help people with cancer.
Your doctor or nurse may suggest you take part in a clinical trial. You can also suggest the idea. Before you agree to be in a clinical trial, learn about:

• Benefits. All clinical trials offer quality cancer care. Ask how this clinical trial could help you or others. For instance, you may be one of the first people to get a new treatment or drug.



• Risks. New treatments are not always better or even as good as standard treatments. And even if this new treatment is good, it may not work well for you.



• Payment. Your insurance company may or may not pay for treatment that is part of a clinical trial. Before you agree to be in a trial, check with your insurance company to make sure it will pay for this treatment.

Tips for Meeting With Your Doctor or Nurse

• Make a list of your questions before each appointment. Some people keep a "running list" and write down new questions as they think of them. Make sure to have space on this list to write down the answers from your doctor or nurse.



• Bring a family member or trusted friend to your medical visits. This person can help you understand what the doctor or nurse says and talk with you about it after the visit is over.



• Ask all your questions. There is no such thing as a stupid question. If you do not understand an answer, keep asking until you do.



• Take notes. You can write them down or use a tape recorder. Later, you can review your notes and remember what was said.



• Ask for printed information about your type of cancer and chemotherapy.



• Let your doctor or nurse know how much information you want to know, when you want to learn it, and when you have learned enough. Some people want to learn everything they can about cancer and its treatment. Others only want a little information. The choice is yours.



• Find out how to contact your doctor or nurse in an emergency. This includes who to call and where to go.

Questions to Ask About My Cancer What kind of cancer do I have? What is the stage of my cancer?About Chemotherapy Why do I need chemotherapy? What is the goal of this chemotherapy? What are the benefits of chemotherapy? What are the risks of chemotherapy? Are there other ways to treat my type of cancer? What is the standard care for my type of cancer? Are there any clinical trials for my type of cancer?About My Treatment How many cycles of chemotherapy will I get? How long is each treatment? How long between treatments? What types of chemotherapy will I get? How will these drugs be given? Where do I go for this treatment? How long does each treatment last? Should someone drive me to and from treatments? About Side Effects What side effects can I expect right away? What side effects can I expect later? How serious are these side effects? How long will these side effects last? Will all the side effects go away when treatment is over? What can I do to manage or ease these side effects? What can my doctor or nurse do to manage or ease these side effects? When should I call my doctor or nurse about these side effects?

Your Feelings During Chemotherapy

At some point during chemotherapy, you may feel:

• Anxious



• Depressed



• Afraid



• Angry



• Frustrated



• Helpless



• Lonely

It is normal to have a wide range of feelings while going through chemotherapy. After all, living with cancer and getting treatment can be stressful. You may also feel fatigue, which can make it harder to cope with your feelings.
How can I cope with my feelings during chemotherapy?

• Relax. Find some quiet time and think of yourself in a favorite place. Breathe slowly or listen to soothing music. This may help you feel calmer and less stressed.



• Exercise. Many people find that light exercise helps them feel better. There are many ways for you to exercise, such as walking, riding a bike, and doing yoga. Talk with your doctor or nurse about ways you can exercise.



• Talk with others. Talk about your feelings with someone you trust. Choose someone who can focus on you, such as a close friend, family member, chaplain, nurse, or social worker. You may also find it helpful to talk with someone else who is getting chemotherapy.



• Join a support group. Cancer support groups provide support for people with cancer. These groups allow you to meet others with the same problems. You will have a chance to talk about your feelings and listen to other people talk about theirs. You can find out how others cope with cancer, chemotherapy, and side effects. Your doctor, nurse, or social worker may know about support groups near where you live. Some support groups also meet online (over the Internet), which can be helpful if you cannot travel.

Talk to your doctor or nurse about things that worry or upset you. You may want to ask about seeing a counselor. Your doctor may also suggest that you take medication if you find it very hard to cope with your feelings.

It is normal to have a wide range of feelings while going through chemotherapy. After all, living with cancer and getting treatment can be stressful.

Chemotherapy Side Effects

What are side effects?
Side effects are problems caused by cancer treatment. Some common side effects from chemotherapy are fatigue, nausea, vomiting, decreased blood cell counts, hair loss, mouth sores, and pain.
What causes side effects?
Chemotherapy is designed to kill fast-growing cancer cells. But it can also affect healthy cells that grow quickly. These include cells that line your mouth and intestines, cells in your bone marrow that make blood cells, and cells that make your hair grow. Chemotherapy causes side effects when it harms these healthy cells.
Will I get side effects from chemotherapy?
You may have a lot of side effects, some, or none at all. This depends on the type and amount of chemotherapy you get and how your body reacts. Before you start chemotherapy, talk with your doctor or nurse about which side effects to expect.
How long do side effects last?
How long side effects last depends on your health and the kind of chemotherapy you get. Most side effects go away after chemotherapy is over. But sometimes it can take months or even years for them to go away.
Sometimes, chemotherapy causes long-term side effects that do not go away. These may include damage to your heart, lungs, nerves, kidneys, or reproductive organs. Some types of chemotherapy may cause a second cancer years later. Ask your doctor or nurse about your chance of having long-term side effects.
What can be done about side effects?
Doctors have many ways to prevent or treat chemotherapy side effects and help you heal after each treatment session. Talk with your doctor or nurse about which ones to expect and what to do about them. Make sure to let your doctor or nurse know about any changes you notice - they may be signs of a side effect.

source:medicinenet.com

Bone Cancer

Bone cancer facts

• The majority of cancer involving the bones is metastatic disease from other remote cancers. Primary bone cancer is much rarer.
• Not all bone tumors are cancerous.
• The most common symptom of bone cancer is pain. The pain is usually mild initially and gradually becomes more intense.
• Treatment of bone cancer includes a combination of surgery, chemotherapy, and radiation therapy.
• Treatment is based on the size and location of the cancer and whether or not the cancer has spread from the bone to surrounding tissues.

What are bones for?

Your body has 206 bones. These bones serve many different functions. First, your bones provide structure to your body and help provide its shape. Muscles attach to the bones and allow you to move. Without the bones, your body would be an unstructured pile of soft tissues and you would be unable to stand, walk, or move. Second, the bones help to protect the more fragile organs of the body. For example, the bones of the skull protect the brain, the vertebrae of the spine protect the spinal cord, and the ribs protect the heart and lungs. Third, the bones contain bone marrow, which produces and stores new blood cells. Finally, the bones help control your body's collection of various proteins and nutrients including calcium and phosphorus.

What is cancer?

Your body is made up of many small structures called cells. There are many different types of cells that grow to form the different parts of your body. During normal growth and development, these cells continuously grow, divide, and make new cells. This process continues throughout life even after you are no longer growing. The cells continue to divide and make new cells to replace old and damaged cells. In a healthy person, the body is able to control the growth and division of cells according to the needs of the body. Cancer is when this normal control of cells is lost and the cells begin to grow and divide in an uncontrolled manner. The cells also become abnormal and have altered functions in patients with cancer. The cancer cells can become very destructive to the surrounding cells and can invade normal organs and tissues, disrupting their function.
There are many different type of cancer. The cancer is usually named based on the type of cell from which the cancer initially grows. For example, lung cancer is caused by uncontrolled cells that form the lungs and breast cancer by cells that form the breast. A tumor is a collection of abnormal cells grouped together. However, not all tumors are cancerous. A tumor can be benign (not cancerous) or malignant (cancerous). Benign tumors are usually less dangerous and are not able to spread to other parts of the body. Benign tumors can still be dangerous. They can continue to grow and expand locally. This can lead to compression and damage to the surrounding structures. Malignant tumors are usually more serious and can spread to other areas in the body. The ability of cancer cells to leave their initial location and move to another location in the body is called metastasis. Metastasis can occur by the cancer cells entering the body's bloodstream or lymphatic system to travel to other sites in the body. When cancer cells metastasize to other parts of the body, they are still named by the original type of abnormal cell. For example, if a group of breast cells becomes cancerous and metastasizes to the bones or liver, it is called metastatic breast cancer instead of bone cancer or liver cancer. Many different types of cancer are able to metastasize to the bones. The most common types of cancer that spread to the bones are cancers of the lung, breast, prostate, thyroid, and kidney. Cancers arising from lymphatic or blood cells, including lymphoma and multiple myeloma, can also frequently affect the bones.
Most of the time, when people have cancer in their bones, it is caused by cancer that has spread from elsewhere in the body to the bones. It is much less common to have a true bone cancer, a cancer that arises from cells that make up the bone. It is important to determine whether the cancer in the bone is from another site or is from a cancer of the bone cells themselves. The treatments for cancers that have metastasized to the bone are often based on the initial type of cancer.

What causes bone cancer?

Bone cancer is caused by a problem with the cells that make bone. More than 2,000 people are diagnosed in the United States each year with a bone tumor. Bone tumors occur most commonly in children and adolescents and are less common in older adults. Cancer involving the bone in older adults is most commonly the result of metastatic spread from another tumor.
There are many different types of bone cancer. The most common primary bone tumors include osteosarcoma, Ewing's sarcoma, chondrosarcoma, malignant fibrous histiocytoma, fibrosarcoma, and chordoma.

• Osteosarcoma is the most common primary malignant bone cancer. It most commonly affects males between 10 and 25 years old but can less commonly affect older adults. It often occurs in the long bones of the arms and legs at areas of rapid growth around the knees and shoulders of children. This type of cancer is often very aggressive with risk of spread to the lungs. The five-year survival rate is about 65%.
• Ewing's sarcoma is the most aggressive bone tumor and affects younger people between 4-15 years of age. It is more common in males and is very rare in people over 30 years of age. It most commonly occurs in the middle of the long bones of the arms and legs. The three-year survival rate is about 65%, but this rate is much lower if there has been spread to the lungs or other tissues of the body.
• Chondrosarcoma is the second most common bone tumor and accounts for about 25% of all malignant bone tumors. These tumors arise from the cartilage cells and can either be very aggressive or relatively slow growing. Unlike many other bone tumors, chondrosarcoma is most common in people over 40 years of age. It is slightly more common in males and can potentially spread to the lungs and lymph nodes. Chondrosarcoma most commonly affects the bones of the pelvis and hips. The five-year survival for the aggressive form is about 30%, but the survival rate for slow-growing tumors is 90%.
• Malignant fibrous histiocytoma (MFH) affects the soft tissues, including muscle, ligaments, tendons, and fat. It is the most common soft-tissue malignancy in later adult life, usually occurring in people 50-60 years of age. It most commonly affects the extremities and is about twice as common in males as females. MFH also has a wide range of severity. The overall five-year survival rate is about 35%-60%.
• Fibrosarcoma is much rarer than the other bone tumors. It is most common in people 35-55 years of age. It most commonly affects the soft tissues of the leg behind the knee. It is slightly more common in males than females.
• Chordoma is a very rare tumor with an average survival of about six years after diagnosis. It occurs in adults over 30 years of age and is about twice as common in males as females. It most commonly affects either the lower or upper end of the spinal column.

In addition to bone cancer, there are various types of benign bone tumors. These include osteoid osteoma, osteoblastoma, osteochondroma, enchondroma, chondromyxoid fibroma, aneurysmal bone cyst, unicameral bone cyst, and giant cell tumor (which has the potential to become malignant). As with other types of benign tumors, these are not cancerous.
There are two other relatively common types of cancer that develop in the bones: lymphoma and multiple myeloma. Lymphoma, a cancer arising from the cells of the immune system, usually begins in the lymph nodes but can begin in the bone. Multiple myeloma begins in the bones, but it is not usually considered a bone tumor because it is a tumor of the bone marrow cells and not of the bone cells.

What are bone cancer symptoms and signs?

The most common symptom of bone tumors is pain. In most cases, the symptoms become gradually more severe with time, including bone pain. Initially, the pain may only be present either at night or with activity. Depending on the growth of the tumor, those affected may have symptoms for weeks, months, or years before seeking medical advice. In some cases, a mass or lump may be felt either on the bone or in the tissues surrounding the bone. This is most common with MFH or fibrosarcoma but can occur with other bone tumors. The bones can become weakened by the tumor and lead to a fracture after little or no trauma or just from standing on the affected bone. This can occur with both benign and malignant tumors. Even benign tumors can spread locally and weaken the surrounding bone. If the tumor compresses the surrounding nerve it can cause pain, numbness, or tingling in the extremities. If the surrounding blood vessels are compressed, it can affect the blood flow to the extremities. Fever, chills, night sweats, and weight loss can occur but are less common. These symptoms are more common after spread of the tumor to other tissues in the body.

How is bone cancer diagnosed?

The first thing your doctor will do is to take a complete medical history. This will include a review of your past health issues as well as early symptoms and the progression of symptoms currently. It will give your doctor clues as to your diagnosis. Some types of cancer are more common in people if they have close family members who have had that type of cancer. Some types of cancer, specifically lung cancer, are more common in people with a history of smoking. A description of your symptoms can help your doctor identify the possibility of bone cancer from other possible causes. Next, a complete physical examination can help find the cause of your symptoms. This may include testing your muscle strength, sensation to touch, and reflexes. Certain blood tests can be ordered that can help to identify a possible cancer.
Next, your doctor will likely order some imaging studies. Plain X-rays are often ordered first. In some cases, if the cancer is identified very early, it may not show up on plain X-rays. The appearance of a tumor on the X-ray can help determine the type of cancer and whether or not it is benign or malignant. Benign tumors are more likely to have a smooth border while malignant tumors are more likely to have a ragged border on X-ray images. This is because the benign tumors typically grow more slowly and the bone has time to try to surround the tumor with normal bone. Malignant tumors are more likely to grow more quickly, not giving the normal bone a chance to surround the tumor. The X-rays can also be used to identify if a fracture has occurred or if the bone has been weakened and is at risk for a potential fracture.
A CT scan (CAT scan or computed tomography) scan is a more advanced test that can give a cross-sectional picture of your bones. This test gives very good detail of your bones and is better able to identify a possible tumor. It also gives additional information on the size and location of the tumor.
An MRI (magnetic resonance imaging) is another advanced test that can also provide cross sectional imaging of your body. The MRI provides better detail of the soft tissues, including muscles, tendons, ligaments, nerves, and blood vessels than a CT scan. This test can give better detail on whether or not the bone tumor has broken through the bone and involved the surrounding soft tissues.
A bone scan is a test that identifies areas of rapidly growing or remodeling bone. The bone scan is often taken of the entire body. This test may be ordered to see if there are any other areas of bone involvement throughout the body. This test is not specific for any specific type of tumor and can be positive with many other conditions including infection, fracture, and arthritis.
If a tumor is identified, your doctor will use all of the information from the history and physical examination along with the laboratory and imaging studies to put together a list of possible causes (differential diagnosis).
Your doctor may then obtain a biopsy sample of the tumor. This involves taking a small sample of the tumor that can be examined in the laboratory by a pathologist (a physician with special training in tissue diagnosis) to determine what kind of tumor it is. The biopsy can be obtained either through a small needle (needle biopsy) or through a small incision (incisional biopsy). The various imaging studies will be used to determine the safest and easiest location from which to obtain the biopsy sample.

What is the treatment for bone cancer?

There are many different methods available for your doctor to treat bone cancer. The best treatment is based on the type of bone cancer, the location of the cancer, how aggressive the cancer is, and whether or not the cancer has invaded surrounding or distant tissues (metastasized). There are three main types of treatment for bone cancer: surgery, chemotherapy, and radiation therapy. These can be used either individually or combined with each other.
Surgery is often used to treat bone cancer. The goal of surgery is usually to remove the entire tumor and a surrounding area of normal bone. After the tumor has been removed, a pathologist examines it to determine if there is normal bone completely surrounding the tumor. If a portion of the cancer is left behind, it can continue to grow and spread, requiring further treatment. If the tumor specimen has normal cells completely surrounding it, there is a much better chance that the entire tumor has been removed and less chance for recurrence. Historically, amputations were frequently used to remove bone cancer. Newer techniques have decreased the need for amputation. In many cases, the tumor can be removed with a rim of normal bone without the need for an amputation. Depending on the amount of bone removed, the surgeon will replace something in its location. For smaller areas, this may be either bone cement or a bone graft from another place in your body or from the bone bank. For larger areas, the surgeon may place larger grafts from the bone bank or metal implants. Some of these metal implants have the ability to lengthen when used in growing children.
You may be referred to a medical oncologist for chemotherapy. This is the use of various medications used to try to stop the growth of the cancer cells. Chemotherapy can be used prior to surgery to try to shrink the bone tumor to make surgery easier. It can also be used after surgery to try to kill any remaining cancer cells left following surgery.
You could also be referred to a radiation oncologist for radiation therapy. The radiation therapy uses high-energy X-ray aimed at the site of the cancer to try to kill the cancer cells. This treatment is given in small doses daily over a period of days to months. As with chemotherapy, radiation therapy can be used either before or after a potential surgery, depending on the specific type of cancer.

What are the side effects of treatment for bone cancer?

Unfortunately, there are risks and side effects with each of the treatments for bone cancer. The main risks associated with surgery include infection, recurrence of the cancer, and injury to the surrounding tissues. In order to remove the entire cancer and reduce the risk of recurrence, some surrounding normal tissue must also be removed. Depending on the location of the cancer, this may require the removal of portions of bone, muscle, nerves, or blood vessels. This could cause weakness, loss of sensation, and the risk of fracture of the remaining bone. You could be referred to a rehabilitation specialist for physical and occupational therapy after surgery to try to improve your strength and function.
Chemotherapy uses very powerful medication to try to kill cancer cells. Unfortunately, some normal cells are also killed in the process. The medications are designed to kill rapidly dividing or growing cells. The normal cells that are affected often include hair, blood-forming cells, and cells lining the digestive system. Side effects include nausea and vomiting, loss of hair, infection, and fatigue. Fortunately, these side effects usually resolve after the chemotherapy is over. Good nutrition is important for your body to fight the cancer. You may be referred to nutrition specialist to help with this, especially if you experience nausea and loss of appetite.
The main side effects from radiation therapy include fatigue, loss of appetite, and damage to the surrounding skin and soft tissues. Prior radiation therapy can also increase the risk of wound problems from surgery in the same area

What does the future hold for patients with bone cancer?

There has been much recent advancement in the understanding and treatment of bone cancer. These developments have led to more focused radiation therapy techniques to reduce the risk to surrounding tissues, better combinations of chemotherapy with less risk and side effects, and improved treatment options, including limb-salvaging surgery, that decrease the need for amputation.
There is currently much work being conducted in each of these areas as well as investigations into the causes of cancer. It is hoped that a better understanding of the specific causes of cancer will lead to gene-therapy techniques to target specific cancer cells with limited risk to other normal cells.

Can bone cancer be prevented?

No. There is no method of preventing bone cancer.
source:medicinenet.com

Chiggers (Chigger Bites)

What are chiggers?

Chiggers are the juvenile form (larvae) of a certain type of mite of the family Trombiculidae. Mites are arachnids (like spiders and ticks).
Chiggers are found throughout the world. They most commonly live in forests, grassy fields, gardens, parks, and in moist areas around lakes or rivers. Most of the larvae that cause chigger bites are found on plants that are relatively close to the ground surface, because they require a high level of humidity for survival.

What do chiggers look like?

Chiggers are barely visible to the naked eye (their length is less than 1/150th of an inch). They are red in color and may be best appreciated when clustered in groups on the skin. The juvenile forms have six legs, although the (harmless) adult mites have eight legs.
Picture of Chigger Eggs, Larvae, Nymph, and Adult

How do chiggers bite humans?

Chigger mites infest human skin via areas of contact with vegetation, such as pant cuffs or shirt sleeves and collars. They migrate on the skin in search of an optimal feeding area. A common myth about chiggers is that they burrow into and remain inside the skin. This is not true. Chiggers insert their feeding structures into the skin and inject enzymes that cause destruction of host tissue. Hardening of the surrounding skin results in the formation of a feeding tube called a stylostome. Chigger larvae then feed upon the destroyed tissue. If they are not disturbed (which is rarely the case because of they cause substantial itching) they may feed through the stylostome for a few days.
The chigger's mouth and feeding structures are delicate and are best able to penetrate the skin at areas of wrinkles, folds, or other areas of skin that are thin. Most bites occur around the ankles, the crotch and groin areas, behind the knees, and in the armpits. Barriers to migration on the skin such as belts may be one reason that chigger bites also commonly occur at the waist or at other areas where their migration is prevented by compression from clothing.

What are the symptoms of chigger bites?

A chigger bite itself is not noticeable. After the chigger has begun to inject digestive enzymes into the skin (usually after about 1-3 hours), symptoms typically begin.

• Pronounced itching is the most common symptom.
  
• The area of the bite may be reddened, flat, or raised; sometimes it resembles a pustule or blister.
  
• The itch is due to the presence of the stylostome and usually is most intense within 1-2 days after the bite.
  
• The itching persists for several days, and complete resolution of the skin lesions can take up to two weeks.

What is the treatment for chigger bites?

Many home remedies for chigger bites are based upon the incorrect belief that chiggers burrow into and remain in the skin. Nail polish, alcohol, and bleach have been applied to the bites to attempt to "suffocate" or kill the chiggers. But because the chiggers are not present in the skin, these methods are not effective.
Treatment for chigger bites is directed toward relieving the itching and inflammation. Calamine lotion and corticosteroid creams may be used to control itching. Oral antihistamines, such as diphenhydramine (Benadryl), may also be used for symptom relief.

What are complications of chigger bites?

Chigger bites themselves do not produce any long-term complications. However, because of the intense itching, prolonged scratching may lead to skin wounds that may become infected by bacteria.

How can chigger bites be prevented?

Washing with soap and water after outdoor activity may remove any chiggers that may be migrating on the skin and prevent their bites. Likewise, washing clothing that was worn outdoors will kill any chiggers remaining on the clothing.
Attention to the outdoor temperature can help with prevention of chigger bites. Chiggers do not bite at colder temperatures (below 60 F or 15.5 C). Chiggers also are not found in areas hotter than 99 F or 37.2 C, so hot rocky areas on sunny days can provide chigger-free seats.
As with mosquito bites, proper outdoor clothing can help prevent chigger bites. Long pants and long-sleeved shirts as well as thick socks and high shoes or boots can help prevent infestation. Pants legs should be tucked into shoes or boots if possible.
All mosquito repellents (such as DEET), applied to skin and clothing, are effective at repelling chiggers.

Chiggers At A Glance

• Chiggers are the larval (juvenile) form of a type of mite (Trombiculidae).
  
• Chiggers do not burrow into and remain inside the skin, contrary to popular belief.
  
• Chiggers inject digestive enzymes into the skin and feed upon the decomposed tissue.
  
• Pronounced itching is the main symptom of chigger bites.
  
• Bites may appear as blisters or as flat or raised red areas.
  
• Treatment involves supportive measures to control itching
• source:medicinenet.com

Shingles (Herpes Zoster)

Shingles facts

• Shingles is caused by the same virus that causes chickenpox and can be spread to people who have not had chickenpox.
• Shingles, also known as herpes zoster, is not related to the sexually transmittedherpes virus disease called herpes genitalis, or the oral herpes virus, herpes simplex.
• Shingles may cause pain that can continue after the rash disappears.
• Steroids and antiviral drugs can help prevent long-term pain after shingles if they are started within the first two days of the appearance of the rash.
• The Zostavax vaccine is available for people over 60 years of age to reduce the incidence and severity of shingles.

What is shingles? What causes shingles?

Shingles is a skin rash caused by a nerve and skin inflammation from the same virus that previously caused chickenpox. This virus is called the varicella zoster virus (VZV) and belongs to the herpes family of viruses. After an individual has chickenpox, this virus lives dormant in the nervous system and is never fully cleared from the body. Under certain circumstances, such as emotional stress, immune deficiency (from AIDS or chemotherapy), or with cancer, the virus reactivates and causes shingles. In most cases of shingles, however, a cause for the reactivation of the virus is never found. Anyone who has ever had chickenpox is at risk for the development of shingles, although it occurs most commonly in people over the age of 60. It has been estimated that up to 1,000,000 cases of shingles occur each year in the U.S.
The herpes virus that causes shingles and chickenpox is not the same as the herpes viruses that causes genital herpes (which can be sexually transmitted) or herpes mouth sores. Shingles is medically termed herpes zoster

What are shingles symptoms and signs? How long does shingles last?

Even when there is no rash, the pain of shingles may be apparent. Before a rash is visible, the patient may notice several days to a week of burning pain and sensitive skin. When the characteristic rash is not yet apparent, it may be difficult to determine the cause of the often severe pain. Shingles rash starts as small blisters on a red base, with new blisters continuing to form for three to five days. The blisters follow the path of individual nerves that come out of the spinal cord in a specific "ray-like" distribution (called a dermatomal pattern) and appear in a band-like pattern on an area of skin. The entire path of the affected nerve may be involved, or there may be areas in the distribution of the nerve with blisters and areas without blisters. Generally, only one nerve level is involved. In a rare case, more than one nerve will be involved. Eventually, the blisters pop, and the area starts to ooze. The affected areas will then crust over and heal. The duration of the outbreak may take three to four weeks from start to finish. On occasion, the pain will be present but the blisters may never appear. This can be a very confusing cause of local pain.

How long is shingles contagious?

Shingles is contagious and can be spread from an affected person to babies, children, or adults who have not had chickenpox. But instead of developing shingles, these people develop chickenpox. Once they have had chickenpox, people cannot catch shingles (or contract the virus) from someone else. Once infected, however, people have the potential to develop shingles later in life.

What does shingles look like?

Shingles is contagious to people who have not previously had chickenpox, as long as there are new blisters forming and old blisters healing. Similar to chickenpox, the time prior to healing or crusting of the blisters is the contagious stage of shingles. Once all of the blisters are crusted over, the virus can no longer be spread and the contagious period is over

How is shingles diagnosed?

The clinical appearance of shingles, with characteristic painful blisters localized to the region of a specific nerve, is usually sufficient to establish the diagnosis. No diagnostic tests are usually required. However, particularly in people with impaired immune function, shingles may sometimes not display the characteristic clinical pattern. In these cases, samples from the affected area may be tested in a laboratory, either by culturing the tissue for growth of the virus or by identifying the genetic material of the virus.

What is the treatment for shingles? Should I visit my health care professional?

There are several effective treatments for shingles. Drugs that fight viruses (antivirals), such as acyclovir (Zovirax), valacyclovir (Valtrex), or famciclovir (Famvir), can reduce the severity and duration of the rash if started early (within 72 hours of the appearance of the rash). In addition to antiviral medications, pain medications may be needed for symptom control. Both nonsteroidal anti-inflammatory medications and narcotic pain-control medications may be used for pain management in shingles.
The affected area should be kept clean. Bathing is permitted, and the area can be cleansed with soap and water. Cool compresses and anti-itching lotions, such as calamine lotion, may also provide relief. An aluminum acetate solution (Burow's or Domeboro solution, available at your pharmacy) can be used to help dry up the blisters and oozing.

What are the complications of shingles?

Generally, shingles heals well and problems are few. However, on occasion, the blisters can become infected with bacteria, causing cellulitis, a bacterial infection of the skin. If this occurs, the area will become reddened, warm, firm, and tender. You might notice red streaks forming around the wound. If you notice any of these symptoms, contact your health care professional. Antibiotics can be used to treat these complications.
A more worrisome complication occurs when shingles affects the face, specifically the forehead and nose. In this situation, it is possible, although not likely, that shingles can affect the eye (known as herpes zoster ophthalmicus), leading to loss of vision. If you have shingles on your forehead or nose, your eyes should be evaluated by a health care professional.
A rare complication of shingles is known as Ramsay Hunt syndrome. In this case, the cranial nerves (cranial nerves V, IX, and X) are involved. Symptoms may include peripheral facial nerve weakness and deafness. The typical rash is often observed around the ear and ear canal.

Picture: How the varicella zoster virus causes shingles and postherpetic neuralgia

 

What is postherpetic neuralgia?

The most common complication of shingles is postherpetic neuralgia. This occurs when the nerve pain associated with shingles persists beyond one month, even after the rash is gone. It is a result of irritation of the nerves of sensation by the virus. The pain can be severe and debilitating. Postherpetic neuralgia occurs primarily in people over the age of 50 and affects 10%-15% of people with shingles. There is evidence that treating shingles with antiviral agents can reduce the duration and occurrence of postherpetic neuralgia.
The pain of postherpetic neuralgia can be reduced by a number of medications. Tricyclic antidepressant medications (amitriptyline [Elavil] and others), as well as antiseizure medications (gabapentin [Neurontin], carbamazepine [Tegretol], pregabalin [Lyrica]), have been used to relieve the pain associated with postherpetic neuralgia. In 2012, the FDA approved the use of gabapentin enacarbil (Horizant), previously used for the management of restless legs syndrome, for the treatment of postherpetic neuralgia. Capsaicin cream (Zostrix), a derivative of hot chili peppers, can be used topically on the area after all the blisters have healed, to reduce the pain. Lidocaine pain patches (Lidoderm) applied directly to the skin can also be helpful in relieving nerve pains by numbing the nerves with local lidocaine anesthetic. These options should be discussed with your health care professional.

Can shingles be prevented with a vaccine?

In May 2006, the U.S. Food and Drug Administration (FDA) approved the first vaccine for adult shingles. The vaccine known as Zostavax, is approved for use in adults ages 50 and over who have had chickenpox. The U.S. Centers for Disease Control and Prevention recommends the vaccine for people 60 years of age and over who have had chickenpox. It is a onetime injection (shot) that does not need to be repeated. The shingles vaccine contains a booster dose of the chickenpox vaccine usually given to children. Tests over an initial four-year period showed that the vaccine significantly reduced the incidence of shingles in these older adults. The single-dose vaccine was shown to be more than 60% effective in reducing shingles symptoms, and it reduced the incidence of postherpetic neuralgia (PHN, see above) by at least two-thirds. Studies are ongoing to evaluate the effectiveness of the vaccine over a longer term. Even if you have had shingles, you can still have the vaccine to help prevent future outbreaks.
There are certain contraindications to receiving the shingles vaccine. People with weakened immune systems due to immune-suppressing medications, cancer treatment, HIV disease, or organ transplants should not receive the shingles vaccine because it contains live, weakened viral particles. There is not enough information available from researchers to decide at this point whether Zostavax may be beneficial in people younger than 60 years of age. Pregnant women should not receive the shingles vaccine.
The shingles vaccine has not been shown to cause any serious side effects or health consequences. Minor side effects include redness, soreness, swelling, or itching at the shot site, and headache. It is safe for those who have received the shingles vaccine to be around babies or those with weakened immune systems. It has not been demonstrated that a person can develop chickenpox from getting the shingles vaccine, although some people who receive the vaccine may develop a mild chickenpox-like rash near the injection site. This rash should be kept covered and will disappear on its own.
Since the chickenpox vaccine is now recommended for children, the incidence of chickenpox has been reduced. This is also expected to reduce the incidence of shingles in adults in the future as these vaccinated children age.

Is shingles dangerous in pregnant women?

Pregnant women are susceptible to shingles, but fortunately, shingles in pregnancy is very rare. The antiviral medications described above are considered safe to use in pregnant women, as are most pain-relieving drugs. In the later stages of pregnancy, women should not take nonsteroidal anti-inflammatory medications such as ibuprofen (Advil) or naproxen (Aleve). However, acetaminophen (Tylenol) is considered safe even in the late stages of pregnancy.
The shingles vaccine should not be administered to pregnant women. It is recommended that a woman wait three months before trying to become pregnant after she has received the shingles vaccine.
Having chickenpox during pregnancy has the potential to cause birth defects, depending upon when in the pregnancy the infection occurs. The risk of birth defects is believed to be lower with shingles than with primary chickenpox infection. If you do not know if you have had chickenpox, a blood test can determine whether you have antibodies (immune protection) against the virus. Those who received the chickenpox vaccine as well as those who have previously had chickenpox will have antibodies in their blood that are directed against the VZV virus
source:medicinenet.com